Improved clinical outcomes in response to a 12-week blended digital and community-based long-COVID-19 rehabilitation programme.

Introduction: Two million people in the UK are experiencing long COVID (LC), which necessitates effective and scalable interventions to manage this condition. This study provides the first results from a scalable rehabilitation programme for participants presenting with LC. Methods: 601 adult participants with symptoms of LC completed the Nuffield Health COVID-19 Rehabilitation Programme between February 2021 and March 2022 and provided written informed consent for the inclusion of outcomes data in external publications. The 12-week programme included three exercise sessions per week consisting of aerobic and strength-based exercises, and stability and mobility activities. The first 6 weeks of the programme were conducted remotely, whereas the second 6 weeks incorporated face-to-face rehabilitation sessions in a community setting. A weekly telephone call with a rehabilitation specialist was also provided to support queries and advise on exercise selection, symptom management and emotional wellbeing. Results: The 12-week rehabilitation programme significantly improved Dyspnea-12 (D-12), Duke Activity Status Index (DASI), World Health Orginaisation-5 (WHO-5) and EQ-5D-5L utility scores (all p < 0.001), with the 95% confidence intervals (CI) for the improvement in each of these outcomes exceeding the minimum clinically important difference (MCID) for each measure (mean change [CI]: D-12: -3.4 [-3.9, -2.9]; DASI: 9.2 [8.2, 10.1]; WHO-5: 20.3 [18.6, 22.0]; EQ-5D-5L utility: 0.11 [0.10, 0.13]). Significant improvements exceeding the MCID were also observed for sit-to-stand test results (4.1 [3.5, 4.6]). On completion of the rehabilitation programme, participants also reported significantly fewer GP consultations (p < 0.001), sick days (p = 0.003) and outpatient visits (p = 0.007) during the previous 3 months compared with baseline. Discussion: The blended and community design of this rehabilitation model makes it scalable and meets the urgent need for an effective intervention to support patients experiencing LC. This rehabilitation model is well placed to support the NHS (and other healthcare systems worldwide) in its aim of controlling the impacts of COVID-19 and delivering on its long-term plan. Clinical trial registration: https://www.isrctn.com/ISRCTN14707226, identifier 14707226.

Computed tomography Coronary angiography in rural referral hospitals: A single-Centre experience.

OBJECTIVE: To describe the first 9 months of a newly established computed tomography coronary angiogram (CTCA) over the period of the COVID-19 pandemic. METHODS: A retrospective analysis of the first 9 months of a CT-CA program. DESIGN: Data were collected for the period of June 2020 to March 2021. Information reviewed included demographics, risk factors, renal function, technical factors and outcomes including Calcium Score and Coronary Artery Disease Reporting and Data System (CAD-RADS). SETTING: A single Rural Referral Hospital in regional New South Wales. PARTICIPANTS: Ninety-six CTCAs were reviewed. Ages ranged from 29 to 81 years. 37 (39%) male, 59 (61%) female. 15 (15.6%) identified as Aboriginal and/or Torres Strait Islander. MAIN OBJECTIVE OUTCOMES: CTCA is a viable alternative to invasive coronary angiogram in appropriate populations for regional areas. RESULTS: Eighty-eight (91.6%) were considered technically satisfactory. Mean heart rate was 57 beats per minute with a range of 108. Cardiovascular risk factors included hypertension, dyslipidemia, smoking status, family history and diabetes mellitus. Of patients with CAD-RADS scores 3 or 4 who underwent subsequent invasive coronary angiogram (ICA), 80% were determined to have operator-defined significant stenosis. Significant cardiac and non-cardiac findings were extensive. CONCLUSIONS: CTCA is a safe and efficacious imaging modality for low- to moderate-risk chest pain patients. There was acceptable diagnostic accuracy and the investigation was safe.

The COVID-19 ambulance response assessment (CARA): measuring the psychological stress and preparedness of ambulance staff to deliver care during the first wave of the SARS-COV–2 pandemic in the UK in 2020

BackgroundThe coronavirus infectious disease 2019 (COVID-19) places significant demand on the NHS. This study aimed to measure the preparedness of healthcare professionals working for ambulance services, in both direct-contact patient facing and remote roles, and the impact the COVID-19 pandemic had on their psychological stress and perceived ability to deliver care.MethodsClinicians working for NHS ambulance services were invited to participate in a three-phase sequential online survey during the acceleration phase of the first wave of COVID-19 in the UK. Participants who participated in the first survey and who consented to be re-contacted were asked to complete two further surveys during the peak and deceleration phases of the pandemic. Open and closed-ended questions were used to assess participants’ perceived preparedness in undertaking their clinical duties. In addition, the General Health Questionnaire-12 (GHQ-12) was utilised to measure participants’ anxiety, mood and general health through each phase of the study. A score greater than 12 indicates the participant may be experiencing psychological distress.ResultsPhase one recruited 3717 participants, reducing to 2709 (73%) by phase two and 2159 (58%) by phase three. Overall, mean GHQ-12 scores were 16.5 (± 5.2) during phase one, reducing to 15.2(±6.7) by phase three. Most participants were found to have a GHQ-12 score great than 12 during the first phase (n = 3112, 84%). Factors leading to higher mean GHQ-12 scores were feeling unprepared for the pandemic, a lack of confidence in both using personal protective equipment and managing out of hospital cardiac arrests in patients with confirmed or suspected COVID-19.ConclusionsA significant number of participants reported psychological distress, the reasons for which are multifactorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in delivery of unscheduled, emergency and urgent care under these additional pressures.

Scalable modEls of Community rehAbilitation for Individuals Recovering From COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol-"SeaCole Cohort Evaluation".

Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community. Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment. Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19. Trial Registration: Current Trials ISRCTN ISRCTN14707226 Web: http://www.isrctn.com/ISRCTN14707226.

Time in Nature Associated with Decreased Fatigue in UK Truck Drivers.

Heavy goods vehicle (HGV) driving is recognised as a highly hazardous occupation due to the long periods of sedentary behaviour, low levels of physical activity and unhealthy food options when working. These risk factors combine with shift work and concomitant irregular sleep patterns to increase the prevalence of fatigue. Fatigue is closely linked with stress and, subsequently, poor physiological and psychological health. In parallel, a wealth of evidence has demonstrated the health and wellbeing benefits of spending time in nature. Here, we sought to examine whether spending time in nature was associated with lower levels of fatigue, anxiety and depression in HGV drivers. 89 long-distance drivers (98.9% male, mean ± SD age: 51.0 ± 9 years, body mass index: 29.8 ± 4.7 kg/m2) participating in a wider health promotion programme reported time spent in nature (during and before the Covid-19 pandemic) and symptoms of occupational fatigue, depression and anxiety. After controlling for covariates, truck drivers who visited nature at least once a week exhibited 16% less chronic fatigue prior to the pandemic, and 23% less chronic fatigue and 20% less acute fatigue during the pandemic. No significant differences were observed for either anxiety or depression. As fatigue has a range of physical and mental health sequelae, we propose that increased exposure to natural settings may make a valuable contribution to interventions to promote the health and wellbeing of this underserved group.

Symptômes associés au frottis SRAS-CoV-2-positif chez des enfants de l'Alberta.

CONTEXTE: La recherche sur les enfants atteints d'une infection à coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) a principalement porté sur les enfants amenés aux services des urgences. Nous avons voulu identifier les symptômes plus souvent associés à un frottis SRAS-CoV-2-positif chez les enfants non hospitalisés. MÉTHODES: Nous avons procédé à une étude observationnelle chez des enfants soumis au dépistage et suivis pour une infection à SRAS-CoV-2 confirmée sur des prélèvements de sécrétions nasales, nasopharyngées, de la gorge et autres (p. ex., aspiration nasopharyngée, sécrétions trachéales ou non spécifiées) entre le 13 avril et le 30 septembre 2020 en Alberta. Nous avons calculé les rapports de vraisemblance (RV) positifs entre les symptômes autodéclarés et les frottis SRAS-CoV-2-positifs dans la cohorte entière et dans 3 analyses de sensibilité : tous les enfants présentant au moins 1 symptôme, tous les enfants, symptomatiques ou non, soumis au dépistage par suite d'une recherche de contacts, et tous les enfants de 5 ans et plus. RÉSULTATS: Nous avons analysé les résultats chez 2463 enfants soumis au dépistage de l'infection à SRAS-CoV-2; 1987 enfants se sont révélés positifs et 476 négatifs. Parmi les enfants SRAS-CoV-2-positifs, 714 (35,9 %) n'ont déclaré aucun symptôme. Même si la toux (24,5 %) et la rhinorrhée (19,3 %) étaient les 2 symptômes les plus fréquents chez les enfants ayant contracté le SRAS-CoV-2, elles étaient fréquentes également chez ceux dont les résultats étaient négatifs et ne permettaient pas de prédire un résultat positif (RV positif 0,96, intervalle de confiance [IC] à 95 % 0,81­1,14 et 0,87, IC à 95 % 0,72­1,06, respectivement). L'anosmie/agueusie (RV positif 7,33, IC à 95 % 3,03­17,76), les nausées et vomissements (RV positif 5,51, IC à 95 % 1,74­17,43), les céphalées (RV positif 2,49, IC à 95 % 1,74­3,57) et la fièvre (RV positif 1,68, IC à 95 % 1,34­2,11) ont été les symptômes les plus prédictifs d'un résultat SRAS-CoV-2-positif. Le RV positif pour la combinaison anosmie et agueusie, nausées et vomissements, et céphalées était de 65,92 (IC à 95 % 49,48­91,92). INTERPRÉTATION: Environ les deux tiers des enfants déclarés SRAS-CoV-2-positifs ont manifesté des symptômes, et les symptômes les plus étroitement associés à un frottis SRAS-CoV-2-positif étaient l'anosmie/agueusie, les nausées et les vomissements, les céphalées et la fièvre.

Symptoms associated with a positive result for a swab for SARS-CoV-2 infection among children in Alberta.

BACKGROUND: Research involving children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has primarily focused on those presenting to emergency departments. We aimed to determine the symptoms most commonly associated with a positive result for a SARS-CoV-2 swab among community-based children. METHODS: We conducted an observational study among children tested and followed for SARS-CoV-2 infection using nasal, nasopharyngeal, throat or other (e.g., nasopharyngeal aspirate or tracheal secretions, or unknown) swabs between Apr. 13 and Sept. 30, 2020, in Alberta. We calculated positive likelihood ratios (LRs) for self-reported symptoms and a positive SARS-CoV-2 swab result in the entire cohort and in 3 sensitivity analyses: all children with at least 1 symptom, all children tested because of contact tracing whether they were symptomatic or not and all children 5 years of age or older. RESULTS: We analyzed results for 2463 children who underwent testing for SARS-CoV-2 infection; 1987 children had a positive result and 476 had a negative result. Of children with a positive test result for SARS-CoV-2, 714 (35.9%) reported being asymptomatic. Although cough (24.5%) and rhinorrhea (19.3%) were 2 of the most common symptoms among children with SARS-CoV-2 infection, they were also common among those with negative test results and were not predictive of a positive test (positive LR 0.96, 95% confidence interval [CI] 0.81-1.14, and 0.87, 95% CI 0.72-1.06, respectively). Anosmia/ageusia (positive LR 7.33, 95% CI 3.03-17.76), nausea/vomiting (positive LR 5.51, 95% CI 1.74-17.43), headache (positive LR 2.49, 95% CI 1.74- 3.57) and fever (positive LR 1.68, 95% CI 1.34-2.11) were the symptoms most predictive of a positive result for a SARS-CoV-2 swab. The positive LR for the combination of anosmia/ageusia, nausea/vomiting and headache was 65.92 (95% CI 49.48-91.92). INTERPRETATION: About two-thirds of the children who tested positive for SARS-CoV-2 infection reported symptoms. The symptoms most strongly associated with a positive SARS-CoV-2 swab result were anosmia/ageusia, nausea/vomiting, headache and fever.